Study of prior authorization’s impact on cancer treatment reveals ‘signal of danger’

February 05, 2024

3 min read

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More than one in five people with cancer did not receive clinician-recommended care due to prior authorization requirements, according to study results.

Prior authorization also led to care delay — many of them lasting 2 weeks or longer — as well as increased patient anxiety and administrative burden, findings of a survey-based cross-sectional study showed.

Quote from Bridgette Thom, PhD

“This study was motivated by the experiences of the clinicians and the patient advocates on our research team, all of whom felt the patient voice was being left out of conversations about prior authorization,” investigator Bridgette Thom, PhD, senior research specialist at Memorial Sloan Kettering Cancer Center, told Healio.

“To date, most of the existing literature focuses on provider perceptions and lost productivity,” Thom added. “While these studies and analyses are important to the bigger picture of the harms of prior authorization, our team felt it was necessary to center the voice of the patient.”

Thom and colleagues surveyed 178 people with cancer (88% women; 84% non-Hispanic white; 92% aged younger than 65 years) to get their perspective about the impact of prior authorization on cancer care.

Results showed 22% of patients who responded to the survey did not receive recommended care due to denials or delays. More than two-thirds (69%) of respondents reported delays in care due to prior authorization, and three-quarters (73%) of those who experienced care delays experienced delays of 2 weeks or longer.

Results also showed a high patient administrative burden due to prior authorization.

The majority of survey respondents characterized the prior authorization process as bad (40%) or horrible (32%).

Healio spoke with Thom about the findings and their potential implications.

Healio: Why did you focus on patient perspectives toward prior authorization?

Thom: This centering allows us to share the experience of anxiety and fear related to delays in diagnosis, and of the suffering felt when supportive care medications and other treatments are delayed.

Healio: Can you tell us more about how you conducted the study and the main outcomes of interest?

Thom: We developed and tested survey questions with our patient advocate. The main outcomes included prior authorization outcomes — such as approvals/denials and delays — self-reported patient anxiety, patient trust and patient administrative burden, which refers to how much time and effort patients spent dealing with prior authorization.

We recruited study participants using social media and the email lists of cancer advocacy organizations, and participants completed the survey online. Patients also could respond to an open-ended question that allowed them to share their experiences in their own words.

Healio: What did you find?

Thom: Given our recruitment methods, it was likely we would end up with a sample enriched for patients with negative experiences, and the findings indeed were stark. More than two-thirds experienced some sort of delay in their care because of prior authorizations, with 73% of these delays exceeding 2 weeks. In 63% of cases, recommended care ultimately was provided. Prior authorization led to increased anxiety among survey respondents, as well as decreased trust in both the health care system and insurance companies.

Sixty-seven percent of the respondents had to become personally involved in the process, and 20% spent more than 11 hours dealing with prior authorization. It’s important to consider the context, as these delays and these efforts on the part of patients and their caregivers are occurring in the midst of cancer diagnosis and treatment.

Healio: Most survey respondents rated the prior authorization experience as bad or horrible. What are the implications of this finding?

Thom: At the most basic level, these findings shed light on the harms experienced by patients. For starters, their care and their medications are being delayed. Then, not only do patients have to take time out of their day — as they are going through treatment — to manage the multiple stakeholders involved in the prior authorization process, they also are experiencing anxiety about the process. They don’t know if their care will be covered and — if it is not covered — they don’t know if they will be able to afford care.

Healio: Do these findings reveal a potential danger of delayed cancer care due to prior authorization?

Thom: There definitely is a signal of danger, particularly related to potential delays in diagnosis, necessary imaging and symptom management. For example, cancer-related symptom management often focuses on alleviating pain and nausea. Patients who experience delays in receipt of these medications may instead have to opt for more costly alternatives — including ED or urgent care visits — to manage their symptoms. We are working on research to understand the downstream effects of prior authorization on patients.

Healio: What are the potential solutions?

Thom: In a perfect world, there would be no prior authorization in the context of acute illness: Payers could just allow providers to make treatment decisions for their patients. In reality, a number of actions are needed to address the situation. One is awareness of the problem. Our study is a good first step in centering the patient perspective to learn firsthand the real-life physical and psychosocial impacts of insurance companies’ business strategies. Future patient-centered research — with a sample more diverse than the one in our study — is needed to quantify and characterize the downstream consequences of prior authorization. Policy efforts to increase prior authorization transparency and the timeliness of decisions also are needed.


For more information:

Bridgette Thom, PhD, can be reached at Memorial Sloan Kettering Cancer Center, 321 E. 61st St., Office 416, New York, NY 10065; email: [email protected].

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